New Mexico Administrative Code
Title 8 - SOCIAL SERVICES
Chapter 312 - LONG TERM CARE SERVICES - NURSING SERVICES
Part 3 - COST RELATED REIMBURSEMENT OF NURSING FACILITIES
Section 8.312.3.12 - ESTABLISHMENT OF PROSPECTIVE PER-DIEM RATES
Current through Register Vol. 35, No. 18, September 24, 2024
Prospective per diem rates will be established as follows and will be the lower of the amount calculated using the following formulas, or the ceiling:
A. Base year: Rebasing of the prospective per diem rate will take place every three years. Therefore, the operating years under this plan will be known as year one, year two and year three. Because rebasing is done every three years, operating year four will again become year one, etc. Cost incurred, reported, audited or desk reviewed for the provider's last fiscal year which falls in the calendar year prior to year one will be used to rebase the prospective per-diem rate. Rebasing of costs in excess of one hundred and ten percent of the previous year's audited cost per diem times the index (as described further on in these regulations) will not be recognized for calculation of the base year costs. For implementation year one (effective July 1, 1984) the base year is the provider's last available audited cost report prior to January 1, 1984. Rebasing will occur out of cycle for rates effective January 1, 1996, using the provider's FYE 1994 audited cost reports. The rate period January 1, 1996, through June 30, 1996, will be considered year one. The rate period July 1, 1996, through June 30, 1997, will be considered year two, and the rate period July 1, 1997, through June 30, 1998, will be considered year three. The rebasing cycle will resume for rates effective July 1, 1998, and continue as described in the first paragraph of this section. Pursuant to budget availability, any changes to reimbursement, including the decision to rebase rates will be at the department's discretion.
B. Inflation factor to recognize economic conditions and trends during the time period covered by the provider's prospective per diem rate:
C. Incentives to reduce increases in costs: As an incentive to reduce the increases in the costs of operation, the department will share with the provider in accordance with the following formula, the savings below the operating cost ceiling in effect during the state's fiscal year.
I = [1/2(M - N)] <= $2.00
where
M = current operating cost ceiling per diem
N - allowable operating per diem rate based on the base year's cost report
I = allowable incentive per diem
D. Calculation of the prospective per-diem rate: The following formulas are used to determine the prospective per diem rate:
YEAR ONE
PR = BYOC x (1 + [DELTA] MBI) + I + FC
where
PR = prospective per diem rate
BYOC = allowable base year operating costs as described in A above, and indexed as described in B above.
NHI = the change in the MBI as described in B above
I = allowable incentive per diem
FC = allowable facility costs per diem
YEARS TWO and THREE
PR = (OP+ I) x (1 + [DELTA] MBI) + FC
where
PR = prospective per-diem rate
OP= allowable operating costs per diem
I = allowable incentive per diem
NHI = the change in the MBI as described in B above
FC = allowable facility costs per diem
E. Effective dates of prospective rates: Rates are effective July 1 of each year for each facility.
F. Calculation of rates for existing providers that do not have 1983 actuals, and for newly constructed facilities entering the program after July 1, 1984.
G. Changes of provider by sale of an existing facility:
H. Changes of provider by lease of an existing facility:
I. Sale/leaseback of an existing facility: When a sale/leaseback of an existing facility occurs, the provider's prospective rate will remain the same as before the transaction.
J. Replacement of an existing facility: When an existing facility is replaced, the provider's prospective rate will become the sum of:
K. Replaced facility re-entering the medicaid program:
L. Closed facility re-entering the medicaid program: